THIS IS A SHANNON AWARD PROVIDING PARTIAL SUPPORT FOR THE RESEARCH PROJECTS THAT FALL SHORT OF THE ASSIGNED INSTITUTE'S FUNDING RANGE BUT ARE IN THE MARGIN OF EXCELLENCE. THE SHANNON AWARD IS INTENDED TO PROVIDE SUPPORT TO TEST THE FEASIBILITY OF THE APPROACH; DEVELOP FURTHER TESTS AND REFINE RESEARCH TECHNIQUES; PERFORM SECONDARY ANALYSIS OF AVAILABLE DATA SETS; OR CONDUCT DISCRETE PROJECTS THAT CAN DEMONSTRATE THE PI'S RESEARCH CAPABILITIES OR LEAD ADDITIONAL WEIGHT TO AN ALREADY MERITORIOUS APPLICATION. THE APPLICATION BELOW IS TAKEN FROM THE ORIGINAL DOCUMENT SUBMITTED BY THE PRINCIPAL INVESTIGATOR. Health care for rural elders is characterized by fragmentation, limited resources, and lack of care management and coordination. Long exposed to changing environments, rural elders maintain values of independence, family, community, and integrated spiritual/physical/mental health. Institutions such as hospitals, public health nursing, and churches have provided stability and support in uncertain times. In a rapidly changing, economically stressed health care environment, appropriate, locally relevant rural health care programs are needed to capitalize on individual and community strengths and address problems of care management. The purpose of this 4 year competing continuation study is to explore the process and effectiveness of a community-based nursing intervention, parish nursing, developed as a partnership between rural hospitals and churches in two Colorado sites. Specific aims are to: 1) Determine the effects of the intervention on quality of life, health status, satisfaction with parish nursing, and involvement in health care; 2) Determine the effects on health care utilization patterns and cost outcomes; 3) Describe the process of diffusion of the intervention in two communities; 4) Describe the process and outcomes of the intervention from the perspective of participants; and 5) Compare the process and outcomes of the intervention across two geographically and culturally (Hispanic and White, non-Hispanic) diverse populations. The case study design incorporates multiple units of analysis; individuals, family members, congregations, health care providers, and parish nurses. The design combines qualitative and quantitative methods. Aims 1-5 are addressed qualitatively with ethnographic interviews, participant observations, and photography. Ethnographic analysis will be conducted on interview data and field notes, to yield themes and address each aim. Aims 1,2,3,&5, are addressed quantitatively. Analyses include: descriptive; repeated measures MANOVA; descriptive comparative and trend analyses of utilization and actual health care changes, and of the intervention process. Combining results of the two methods through team dialogue, and comparing data across sites, findings will be interpreted and reported. The study's significance is to evaluate process and outcomes of a community-based nursing intervention targeting a vulnerable population and to inform policy for locally relevant, cost-effective, rural health care service.